Long-term follow-up of different refractory systemic vasculitides treated with rituximab
Clinical Rheumatology,  Clinical Article

Rees F et al. – The results of this study provide further evidence that RTX is an effective induction agent in systemic vasculitis. The optimal and long-term outcome of re-treatment remains to be defined.

Methods

  • Retrospective study
  • 15 cases of refractory systemic vasculitis (11 Wegener's granulomatosis, 1 Churg–Strauss syndrome, 1 cutaneous polyarteritis nodosa and 2 cryoglobulinaemic vasculitis) treated with RTX, with mean follow-up of 34 months
  • All had previously received CYC, and 14, at least 1 other immunosuppressive drug
  • All had active disease when treated (median Birmingham Vasculitis Activity Score (BVAS) 2003, 13)

Results
  • All cases achieved remission (BVAS 2003, 0)
  • 13 required re-treatment, 9 due to relapse (mean, 9 months after initial treatment) and 4 because of repopulation or rising ANCA in context of CYC intolerance or previous CYC refractory disease
  • Relapsing cases have been successfully re-treated up to 5 further cycles, either at B cell repopulation or at 6 monthly intervals
  • Infections rare
  • Mean IgG levels fell significantly, and IgM levels became subnormal in 6 cases
  • 3 cases of neutropenia, 1 severe at 10 months post-treatment

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